Descriptive Psychopathology: The Signs and Symptoms of ...

342 Section 3: Examination domainsconcordance among twins, increased prevalence in families of homosexual persons,and evidence of matrilineal heritability. 45 Sexually dimorphic brain structuresof homosexual persons are less masculinized in male homosexuals. 46A selective advantage of a “gay” genotype is proposed that parallels the constructof sickle-cell trait versus sickle-cell disease, the heterozygote having some selectiveadvantage (e.g. being more attractive to the opposite gender). Among exclusivehomosexuals, kin altruism is the proposed advantage, gay aunts and uncleswithout offspring providing extra resources to their nieces and nephews. 47Homosexuality is not a lifestyle choice, nor is it considered a form of illness bymost neuroscientists. Psychoanalytic explanations of homosexuality are discredited.Homosexual persons, however, are at greater risk for sexually transmitted disease. 48Their suicide rates may also be higher. 49 Studies comparing homosexual and heterosexualdrug abusers have found more severe drug abuse, anxiety and risk of suicide inhomosexuals. 50 Homosexual men also have increased risk of suicide even withoutsubstance abuse. 51 HIV or AIDS status does not significantly increase rates ofdepression in homosexual men, but homosexual men as a group do experienceincreased anxiety and depression. 52TranssexualismTranssexuals are persons whose subjective experience of gender identity does notmatch their assigned gender at birth based on their normal external sexualcharacteristics. Transsexuals that come to medical attention state that naturehas played a terrible trick on them and that they are “trapped” in a body of theother gender. The condition is rare, with the assigned male feeling femalethe more common situation. 53Transsexual persons experience their gender inconsistency early in life. Parentsof boys with gender identity disorders report that at a very young age the boysinsisting on being treated as girls and being dressed as girls. 54 Twin studies findincreased heritability for gender identity disorder. 55 Genetically male transsexualsshow a female pattern in sexually dimorphic nuclei of the hypothalamus, indicatingan effect occurring during a critical stage of fetal development. Non-transsexualadult males who take estrogen for medical reasons do not show this pattern. 56DSM-IV uses the term gender identity disorder and requires the individual toexhibit significant distress or impairment in functioning without a concurrentphysical intersex condition (see below). Increased anxiety and depression isreported in some transsexual persons and is termed gender dysphoria. This usuallyresolves after successful sexual reassignment surgery. Some patients, however, arereported to have co-occurring psychotic disorder with the transsexualism consideredan epiphenomenon of the psychosis. 57 There is no significant increase inillicit drug use or alcohol abuse. 58